Who do I vote for if I am against the proposed changes to the NHS?

[Clement]

I've never been into politics much, partly through laziness, partly through "political fatigue" in that politicians have said things for years that they very often later go back on, in short, i don't believe they'l do much if anything of what of what they say.

However, i have to start voting because the only political issue i care about is in danger, the NHS is about to go through changes i am strongly against, they include opening parts of the NHS up to private companies.

I'm not asking whether the proposed changes to the NHS will be a good or bad thing, i've already made up my mind on that matter and won't change it, i'm asking you guys who do i vote for to save the NHS from what i consider to be privatisation through the back-door? all the political parties say they will save it, but who do i believe? who will keep the NHS well funded and free at the point of entry for the british people?

 

[Camikaze]

Hmm, I hadn't heard about this, and it sounds alarming! Have you got a link?

I'd assume Labour would definitely oppose such a sale, so would 'save' it from privatisation.

 

[Clement]

Hmm, I hadn't heard about this, and it sounds alarming! Have you got a link?

I'd assume Labour would definitely oppose such a sale, so would 'save' it from privatisation.

I don't have a link i'm afraid, i've been reading about it in various news sites for some time, policies are being made to open up the NHS to private companies, the politician who is making these moves is called andrew lansley, and i read only yesterday that his wife is an advisor to some of the private companies that stand to benefit from her husbands changes, conflict of interest much?

I'm really frightened and angry about this, i need to know who to vote for, you reckon labour? ok thank you.

 

[Tahuti]

The health care system of the Netherlands was largely privatised in 2006 - for cost-cutting reasons - and ideological complaints from both sides of the debate aside, it hasn't become dramatically worse or less accessible financially. The gov't still is involved to keep it affordable.
However, the Dutch health care system never had the amount government involvement the NHS has.

 

[Arwon]

Depends on the electorate you live in, I'd imagine.

 

[Mise]

Err, the NHS isn't being privatised. Dunno where you got that from, but it's not true.

 

[Clement]

Err, the NHS isn't being privatised. Dunno where you got that from, but it's not true.

From what i understand, it's going to be being opened up to private companies so they can compete for patient's needs, is that not privatisation?

If not, what term should i have used? because i'm against the proposed changes, Camikaze, could you please change the title of my thread to "who do i vote for if i am against the proposed changes to the NHS?" because i'm afraid it seems i've gotten the title wrong.

 

[Mise]

Opening it up to competition from other providers isn't the same as privatising the NHS. Privatising means actually selling off NHS assets (e.g. hospitals) to private companies who operate on a for-profit basis. There's basically no way in hell that they'd ever be able to do this - it would be electoral suicide to privatise the NHS in the UK.

Lansley's proposals have two broad goals. The first is to separate the people who commission healtchare (i.e. GPs [family doctors], who refer cases to hospitals) from the providers of the more expensive treatments (i.e. hospitals, to whom patients are referred by GPs). The idea is that hospitals and GPs would no longer be in each others' pockets; GPs would have control over their own budgets, meaning that they could now refer their patients to whichever hospital offers the best quality services for the lowest price. The downside is that GPs are already kind of busy; adding more admin duties to their schedule would probably mean they'd have to hire help from a 3rd party, which might end up costing more than the previous system, where a big trust decided all this stuff.

The second plank is to allow more private providers to offer care, too, but there would be something put in place to prevent private providers from cherry-picking the easiest and most profitable cases. The increase in competition would help drive up standards and lower costs, in the same way that when two supermarkets are built next to each other, they drive down costs and increase choice for the consumer. We'd still have standards and targets that need to be maintained, meaning that quality wouldn't suffer as a consequence of lower price. I honestly can't see a downside to this, though there are always risks and unintended consequences. I think the opposition to this is overblown and irrational. It's a HUGE difference between allowing private providers to provide care, and actually selling off the NHS to private providers. The former is additive: it adds to the total stock of hospital beds, medical procedures, doctors, etc that are in this country. The latter is not additive, it's subsitituive: you swap NHS hospital beds for Private hospital beds. Additive is good!

To me, the plan doesn't seem like a terrible idea. The problem, for me, is with its timing; it would cost a crapload of money initially and risks causing major disruptions to services at a time when everyone's budgets are already being squeezed. The proposals were rushed and the government was criticised for it; they have recently watered the changes down, and it looks increasingly likely that the most radical changes will be scrapped altogether. The worst that would happen with these proposals is that it becomes an expensive waste of time. It's nothing like an actual privatisation of the NHS (which would be a bloody disaster, and something I'd oppose absolutely).

Labour is against the proposals. The Lib Dems are mostly against them, too, but being part of government means they can't freely voice their annoyance as loudly as they would have done in opposition. But really, the reforms proposed weren't significantly different from what Labour was proposing back in 1997; Labour ran into similarly loud and vociferous opposition from doctors and nurses, and similarly had to water them down.

I would be VERY wary about trusting doctors when it comes to NHS reform. They generally act as though they're acting in the best interests of medical care, but actually they have a strong tendency to act as self-servingly as any of the professional classes, like lawyers and bankers. At the end of the day, turkeys don't vote for Christmas; doctors will always fight against changes to the NHS, even when those changes are in their patients' best interest. Notice how they fought tooth and nail for massive pay rises a few years ago, even when other public servants were getting squeezed. They're protecting a closed shop; you shouldn't trust them to voice their opinions on NHS changes any more than you should trust a banker's or lawyer's opinions on changes to the rules surround their professions.


(Full Disclosure: My dad's a doctor and my mum also worked in the NHS all her life.)

 

[Clement]

Mise, i was going to ask questions about your post because it is very well written, but i realised that all i'm asking here in this thread is who is going to stop those changes? i've made up my mind and i don't agree with them, nor do i trust the people implementing them.

So far it seems labour is the party i should vote for, i appreciate the help.

I would be VERY wary about trusting doctors when it comes to NHS reform. They generally act as though they're acting in the best interests of medical care, but actually they have a strong tendency to act as self-servingly as any of the professional classes, like lawyers and bankers. At the end of the day, turkeys don't vote for Christmas; doctors will always fight against changes to the NHS, even when those changes are in their patients' best interest. Notice how they fought tooth and nail for massive pay rises a few years ago, even when other public servants were getting squeezed. They're protecting a closed shop; you shouldn't trust them to voice their opinions on NHS changes any more than you should trust a banker's or lawyer's opinions on changes to the rules surround their professions.

You may well have a point there, truth is though that i actually respect doctors, nurses and specialists a lot, not something i can say about politicians, i'd rather listen to what a doctor wants a million times over than what a politician says should happen.

 

[nonconformist]

The Labour Party has broadly been for increased commercial participation in things such as the NHS. Your primary representatives would probably be Lib Dems (*snicker, snicker*) or the Greens (or any other minority party that exists in you constituency)

 

[Mise]

Yeah, if you don't like the proposals, Labour is your best bet.

nor do i trust the people implementing them.

I think this is a really important point. The Conservatives generally disapprove of the NHS on a fundamental level; many Tory MPs would rather the NHS didn't exist, and want it replaced with private providers. Labour, OTOH, firmly support the NHS and want it expanded. So when a Conservative government suggests changes like this, you have to view it from a Conservative lens. The success or failure of these proposals depend on how well they are implemented. A Labour government, who truly believes in the NHS, will naturally throw more resources into its implementation in order to make sure it gets it right. OTOH, a Tory government doesn't really care too much about the NHS so wouldn't put so much effort into implementing it.


(Disclosure, again: I'm a Labour supporter. If it's not already obvious!)

 

[Camikaze]

Moderator Action: Edited the thread title.

 

[Clement]

Moderator Action: Edited the thread title.

Thank you very much

 

[Camikaze]

Disclaimer- my opinion on this is entirely derived from what I've been told by a GP whose a partner in a practice in Essex, so I guess take it with this proviso:

I would be VERY wary about trusting doctors when it comes to NHS reform.

Lansley's proposals have two broad goals. The first is to separate the people who commission healtchare (i.e. GPs [family doctors], who refer cases to hospitals) from the providers of the more expensive treatments (i.e. hospitals, to whom patients are referred by GPs). The idea is that hospitals and GPs would no longer be in each others' pockets; GPs would have control over their own budgets, meaning that they could now refer their patients to whichever hospital offers the best quality services for the lowest price. The downside is that GPs are already kind of busy; adding more admin duties to their schedule would probably mean they'd have to hire help from a 3rd party, which might end up costing more than the previous system, where a big trust decided all this stuff.

I was led to believe that one of the largest barriers to patient care within the NHS at the moment is administrative burden. Too much paperwork, too much bureaucracy. That the unwieldy nature of the NHS made the job of a GP much harder than a decade ago. Less patients can be seen in the same period of time, more receptionists and registrars are needed. Ridiculous annual appraisals must be filled in without actually providing any benefit. All at the same time as detracting from funding that means less batches of vaccine are available. etc.

Is introducing yet more admin duties really a positive step?

Additionally, I was also led to believe that NHS reform involved some sort of bureaucratic shake up in the form of collectivising practices by region. Which discourages efficient practices and could force practices that have managed to remain financially sound out of business. Is anything like this at all the case?

 

[Agent Cooper]

I was led to believe that one of the largest barriers to patient care within the NHS at the moment is administrative burden. Too much paperwork, too much bureaucracy. That the unwieldy nature of the NHS made the job of a GP much harder than a decade ago.

In the Danish system, that's certainly a main concern right now. The money and the political will is there, but way too many resources are wasted on administrative burdens, poor planning and a general lack of flexibility.

It sucks when you spend a fortune of taxpayer funds to buy state of the art scanner stations and educate medical staff in their usage - and then discover that you can only operate them for 4-6 hours a day because of lousy planning schedules, staff allocation, union regulations etc.

Regarding the NHS, I'm a bit surprised of the suggestion that the torys are advocating privatization of the NHS or parts of it. I was under the impression that this was a non-issue in the UK. That the NHS as a public funded operation, had support from all over the political spectrum. But perhaps I'm wrong...?

 

[Mise]

Everyone likes to blame government-imposed red-tape and stifling bureaucracy for everything There's going to be an element of bureaucracy when you have a national health service that serves 60 million people; whether the bureaucracy sits at the GP's desks or in giant Primary Care Trusts doesn't really make a difference to me. That GPs don't like paperwork and therefore dislike any reform that moves paperwork onto GPs is unsurprising. If GPs feel that they are simply not financially savvy enough to handle a bigger budget then fine, they can delegate that task if they want to. Nobody expects a simple family doctor to be able to do accounts

Ultimately, we won't know whether this increases or decreases costs and red tape overall until after it's done. In terms of red-tape, it's a structural change that shifts admin duties from one place to another. It might be cheaper for GPs to do more paperwork than to create a giant regional Primary Care Trust to do all the paperwork (as is the case now). Who knows. I certainly don't. All I know is that everyone and their dog whines about red tape and bureaucracy and big government giving them all these rules and regulations to follow. Of course they do - nobody likes filling out paperwork and appraisals - but it has to be done by someone...

In the past, doctors have always moaned about changes to the health service, saying that the new system will be worse than the current one. The changes eventually happen, and the doctors eventually get used to the new system. And then 5 years down the line, when the next government makes its changes, those same doctors kick and scream about how this current is the best system we have and that the new system will be worse.... And so it goes, after every election...

 

[Camikaze]

I think the problem with budgeting and collectivisation was more that the budgeting would be moved out of the GPs hands to some extent, which isn't exactly what they want when they've bought into the practice.

As for the administrative issues, although I can certainly see what you're saying, would you say there's a point where you can say that the doctors are actually right? Sure, they might complain because of their vested interest, but there could be something of boy crying wolf to it, in that constant complaints and adaptation don't necessarily make them wrong. Anecdotally, the same number of GPs (with a much larger bureaucracy above them) provide a far lower amount of care than a decade ago. I'd be curious to see if there is any empirical basis for this, but if it is so, then that does strike me as being an indictment of bureaucracy. When is the point reached where we can say that the bureaucracy is too burdensome, or how can we say that the NHS is not there yet?

 

[Mise]

I don't know enough about the specifics to say whether some GPs will actually see less control over their budgets than before. I was under the impression that GPs are supposed to have more control over their budgets; that seemed to be one of the main thrusts of the proposals. There are probably nuances that I'm not aware of though, I don't know.

The problem is, when doctors say they're getting more and more bureaucracy, it's because the actual bureaucrats are getting fired. 20 years ago, with a pinch of salt and some gross caricaturisation, we had armies of bureaucrats and such who did nothing but push paper around. Now, those bureaucrats are gone, but the work has shifted onto doctors. So doctors see more and more bureaucracy, but actually the reason they see more of it is because there are fewer actual, wasteful bureaucrats around. It was the same with the police: they made cuts to back-office staff, but that meant that police officers had to do more of the paperwork themselves. So officers complained about increased bureaucracy, exactly because there are fewer bureaucrats. Whether it's cheaper to pay officers to do paperwork or pay someone else to do it is another question, but that's exactly my point: we won't know whether it's better or worse until after it's done. All these arguments are just speculation.

And it's not like all of these changes are in one direction, either. Labour, in general, created more layers of bureaucracy above doctors. The Tories, in general, are removing those layers and handing that bureaucracy back down to the doctors. Those two changes can't both be bad, surely.

 

[SeekTruthFromFacts]

It's also worth pointing out that giving doctors more control over their budgets inevitably means they will spend more time filling in forms and writing reports, and less time treating patients. That seems to be an absurd use of a professional who has spent 7 years learning to treat patients, and no time studying management.

I once went to a 'Milk Round' presentation where they were recruiting trainee NHS managers. I left feeling scared. The recent recruit they brought along seemed to be a very tough cookie, and they seemed to be almost putting people off the job.

 

[SeekTruthFromFacts]

It's also worth pointing out that giving doctors more control over their budgets inevitably means they will spend more time filling in forms and writing reports, and less time treating patients. That seems to be an absurd use of a professional who has spent 7 years learning to treat patients, and no time studying management.

I once went to a 'Milk Round' presentation where they were recruiting trainee NHS managers. I left feeling scared. The recent recruit they brought along seemed to be a very tough cookie, and they seemed to be almost putting people off the job.